Pneumatosis Intestinalis in Adults

The finding of pneumatosis on imaging is a frequent cause for consultation to surgical services. Yet the etiology of the gas itself may be benign. Pathologic forms are typically associated with bowel ischemia or necrosis. We have developed a grading scale to assist with the identification of pneumatosis associated with pathologic etiologies as well as recommendations on management. In addition to a good history and physical examination, the presence of a lactate level 2 mmol/L or greater, signs or symptoms of sepsis, hypotension, portal venous gas on imaging, and peritonitis should direct the clinician toward abdominal exploration.